UNITED STATES OF AMERICA

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UNITED STATES OF AMERICA

in use. From this beginning it seems probable that in a short time all the larger hospital centres in France and North Africa will have an iron lung which is most likely to be wooden. Those who read Dr. C. L. G. Pratt’s letter in your issue of Jan. 28 will recall that the first mechanical respirator was devised by a French clinician, Dr. Woillez, who described a form of congestion of the lung which now goes by his name. Dr. Woillez demonstrated his apparatus in 1876 at the Academy of Medicine, in whose bulletin were published the two engraved plates which you reproduced with Dr. Pratt’s letter. The pump was worked by hand, a feature that might well prove useful should electric power be put out of action, for instance during an air-raid.

Prof. Laignel-Lavastine of the International Neo-

Hippocratic Society has sent to leading medical men in various countries a letter asking for support for the second congress to be held in France towards the end of the present year. Neo-hippocratism, since the idea was launched some years ago from London by Cawadias, has found acceptance in medical circles here, bfficial and non-official, as a meeting-ground for homoeopathic and allopathic doctors. A physician acting as social insurance controller lost his own self-control enough to tell a patient in a loud voice what he thought of the surgeon who had treated him. The surgeon, who has a high standing in Paris, having heard of what had happened, sued the controller for slander and was awarded 1000 francs in damages. The fine will be paid by the caisse, regarded as responsible in civil law. The French Society for Serology, founded in 1931, has extended its activities and its title to chemotherapy. At a special meeting held in Paris the guests of honour were Dr. P. R. Peacock (Glasgow) and Prof. Maisin (Louvain) who delivered lectures respectively on serology and the diagnosis of cancer. Prof. Pachon, one of the leading French physiologists, has died in retirement. His life work was principally on blood-pressure and the instrument for its measurement, the oscillometre Pachon, is still in use with slight modification in most Latin countries. He spent his life in laboratory work and in teaching, and was the perfect type of savant eager only for the discovery of truth behind the complexity of natural phenomena. UNITED STATES OF AMERICA (FROM OUR OWN CORRESPONDENTS) THE DOCTOR AND THE SOCIOLOGIST

AT a meeting on health insurance convened by the American Association for Social Security on April 14 and 15 the views of the American Medical Association were presented by Dr. Morris Fishbein, editor of its journal. If the indigent in the United States are not getting medical care in every case, he said, it is because the social-welfare profession have failed miserably in bringing the sick to the sources of such care. However, the indigent in this country are better cared for than in any country in the world. Health insurance, in Dr. Fishbein’s opinion, exalts administration above service. It results in a low grade of practice and if introduced under the Wagner bill would put medical care under political control. Miss Helen Hall, president of the National Federation of Settlements, spoke in favour of health insurance

and especially of the British health-insurance adminitration. She paid a tribute to the friendly attitudes of the British working classes to those who had come over to inquire regarding their experiences under health insurance. Lor, miss," they had said to her, " Ain’t your accent funny ! We thought it was just made up for the movies ! " She hoped that any scheme for health insurance introduced in the United States would provide for the entire family. Dr. Hugh Cabot put " the case of the progressive doctor." He agreed with Dr. Fishbein that no-one wants complete security ; but we do want a little less insecurity. In spite of good public-health statistics in this country, it is undeniable that large groups of people get nothing that can be called adequate medical care. Dr. Cabot then eulogised the standards of scientific medical journalism in this country. But medicine, he remarked, is not an abstraction. It may not be surprising that physicians are unable to keep abreast of sociology and economics ; yet these are fields in which his advice will be asked. Excellent as are our medical publications in their own sphere, they are not so good in the sphere of economic and social problems. Too frequently we have been treated to special pleading and to dogmatism by writers who are ignorant of fundamental facts; too often there has been descent to emotionalism. Physicians find it difficult to realise that it is not possible to set up in social questions the type of experiment, with few variables and adequate control, to which they are accustomed in natural science. In sociology what we set up is a "trial," not an experiment, and crabwise we proceed by the old method of trial and error. The public recognises that physicians are experts in their own field and is willing to treat them as such ; but the profession must not expect to be treated as expert in sociology and economics. "

MEDICAL CARE IN THE COAL-FIELDS

A report on conditions of medical service and hospitalisation in the coal-mining areas of Southern West Virginia, Virginia, Eastern Kentucky, and Northern Tennessee has just been issued by the Bureau of Cooperative Medicine (5 East 57th Street, New York City). It is based on interviews with 787 miners and their wives, with 75 doctors and "30 or 40 other persons," and inspection of 38 hospitals. The report states that " the miners of these districts are receiving deplorable medical service from their camp doctors, are constantly opposed by them in any dispute with the companies, and at present have no means of forcing better standards. For these things they are paying regular fees of approximately$2,500,000 a year, plus another million in extra charges, of which a large proportion is diverted into the pockets of the companies and contract doctors who sublet the work."

The

hospitals

in this

area

are

exceptions privately owned and

with almost for profit

run

no

by

the doctors who work in them. They supply only about 2-5 beds per 1000 population and the men pay exorbitantly high rates for their support. Since the hospitals are maintained by per-capita payments, each patient is a liability. It is reported that one unmarried man living alone was discharged while still in a solid plaster cast from his armpits to his left ankle. There is a serious lack of trained nurses. The equipment, though fairly good for emergency surgery, is wretched in other respects. Medical records are so poor as to be of little assistance either in future sicknesses or in compensation hearings.

VIENNA.-MEDICINE AND THE LAW

The miners are severely handicapped in obtaining medical and cash benefits to which they are entitled under the Workmen’s Compensation Acts, because of the widespread company domination of doctors and hospitals. The bureau recommends the formation of voluntary non-profit group health associations.

(FROM

OUR

VIENNA OWN CORRESPONDENT)

ERNST FINGER

Prof. Ernst Finger, formerly chief of the Vienna clinic for dermatology and syphilis, has died at the age of 83. He was educated at the universities of Prague and Vienna, and first held the post of chief assistant in the department for diseases of the skin at the Vienna General Hospital. In 1904 he was appointed director of the clinic. Under his guidance its fame grew, and students from all over the world were eager to attend his classes and to work under him. His books on diseases of the skin and the sexual organs, which were translated into many languages including Chinese and Japanese, added to his reputation. His chief interest was in the fight against venereal diseases, and in 1907 he organised a chain of centres for the treatment of gonorrhoea and syphilis throughout Austria, including a number of evening outpatient centres where men and women could obtain treatment without loss of working time. A follow-up department kept these patients under observation after they were cured. It was on his advice also that leaflets of instruction were distributed among the working classes. His work in the period during and immediately after the late war was especially valuable, for at that time the prevalence of venereal infection among the population was very high. Finger was the prime mover in an effort that was made to introduce a bill to the Austrian Parliament making the notification of venereal diseases compulsory, but the attempt was unsuccessful. In 1927 on reaching the retiring age he gave up his position at the clinic which has since been taken over by the University of Vienna. Finger’s kindly interest in his pupils in all parts of the world never flagged, and many will remember him gratefully as a research worker, a teacher, and sociologist. GOITRE IN AUSTRIA

monograph on the prophylaxis of goitre by Wagner-Jauregg, published by the Ministry Health, contains a remarkable body of statistical

A

Prof.

of data on the incidence of this condition in Austria. In 1923-24 a systematic examination of all schoolchildren in the country was carried out, the results being entered on a special form similar to that used in Switzerland by Bayard. The findings had to be entered by the school doctor under four headings :

goitre ; (2) incipient goitre ; (3) slight enlargethyroid ; and (4) well-developed goitre. Altogether 686,000 children between 6 and 14 years were reported on, of whom 44 per cent. of boys and 49 per cent. of girls had a goitre in various stages. The highest rate was found in the mountainous province of Vorarlberg-Tyrol, which showed an incidence of 59 per cent. in boys and 63 per cent. in girls ; the lowest was in the low-lying province of (1)

no

ment of the

Burgenland, with an incidence boys and 20 per cent. in girls. figures for Vienna were 41 and Wagner-Jauregg thought that

of 16 per cent. in The corresponding 46 per cent. Prof. these high figures

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an ephemeral wave of goitre, the legacy of the war and immediate post-war years, when food and especially vitamins were scarce. This is borne out by the results of subsequent examinations, though these have not been conducted on such a large scale. In 1931-32 the incidence of definite goitre had fallen in the worst regions to a tenth or less of what it was in 1921, and in 1937 the figures were even better. In 1924 preventivemeasures were instituted by the health authorities. Since then only iodised salt, as introduced by Grange in Geneva and Hunziker in Zurich in the 50’s, has been sold to the public for ordinary use. This Vollsalz contains 5 mg. of potassium-iodide in each kilogramme of salt, or 1 part in 200,000, and its effect seems to have been highly satisfactory. Prof. Wagner-Jauregg also discusses the relation to goitre of deaf-mutism and endemic cretinism, both of which are relatively common in the mountainous districts. In cretinism iodised salt is expected to act not so much on the cretins themselves as on their goitrous progenitors.

represented

MEDICINE AND THE LAW

rejects Medical Certificate IN Rex v. Boycott and others, ex parte Keasley, the High Court has quashed a medical certificate signed by two doctors which certified a boy to be an imbecile within the meaning of the Mental Deficiency Acts. Stanley Keasley, 11 years old, attended the Harpenden council school for some years. In 1937 the headmaster told his father that Stanley was to be medically examined. The examination took place, High

Court

and the father afterwards received a letter from the Harpenden local education subcommittee stating that the boy was to be examined with a view to his transfer to a special school. The father strongly objected; he considered his son nt for ordinary elementary education ; he had his son examined by his own doctor who reported him capable of being educated at the council school; this report was said to have been later confirmed by a specialist. In October, 1938, the father was notified that a certi. ficate had been signed to the effect that the boy was incapable of being educated at the council school and it was suggested that he should be sent to a special institution. The father then moved the High Court for an order of certiorari to quash three documents-namely, (1) the certificate of Oct. 5, 1938, signed by twodoctors and purporting (under the Mental Deficiency (Notification of Children) Regulations of 1928) to declare Stanley Keasley to be an imbecile ; (2) a report of the same date by the first of the two certifying doctors ; and (3) a notification dated Oct. 10, 1938, from the clerk to the education committee sent to the county council’s Mental Deficiency Act committee, requesting the latter to consider the advisability of transferring the boy to the special institution. The father’s motion cited the Herts county council, the Harpenden education subcommittee, and the two doctors as respondents. It was possible to criticise the treatment of the boy’s case in two respects. First, in making it the duty of the local education authority to ascertain what children are defective and whether a child is incapable of receiving instruction in a particular school, section 31 of the Mental Deficiency Act of 1913 stipulates that any case of doubt must be determined by the Board of Education. The father had asked that the matter be referred to the board